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Purpose-To evaluate the efficacy of two, theory-based, multi-media, middle school sexual education programs in delaying sexual initiation.Methods-Three-armed, randomized controlled trial comprising fifteen urban middle schools; 1,258 predominantly African-American and Hispanic 7 th grade students followed into 9 th grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.Results-Participants were 59.8% female, mean age 12.6 years. Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal or anal sex) in the overall sample (adjusted odds ratio [AOR]: 0.65, 95% CI: 0.54-0.77), among females (AOR: 0.43, 95% CI: 0.31-0.60) and African-Americans (AOR: 0.38, 95% CI: 0.18-0.79). RR students also reduced unprotected sex at last intercourse (AOR: 0.67, 95% CI: 0.47-0.96), past three months' frequency of anal sex (AOR: 0.53, 95% CI: 0.33-0.84) and unprotected vaginal sex (AOR: 0.59, 95% CI: 0.36-0.95). The RA program delayed any sexual initiation among Hispanics (AOR: 0.40, 95% CI: 0.19-0.86), reduced unprotected sex at last intercourse (AOR: 0.70, 95% CI: 0.52-0.93) but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively impacted psychosocial outcomes. program, comparable in duration, delivery, and theoretical framework, to further examine how both approaches impact middle school students. The primary hypothesis tested whether students, who received either the RR or the RA intervention, would delay sexual initiation into 9 th grade relative to controls. Secondary hypotheses tested intervention effects on other sexual behaviors and psychosocial factors. Conclusions-The METHODS Study Design and ParticipantsA randomized controlled trial was conducted from 2006-2010 in fifteen urban middle schools in a large south-central US school district. Seventy-eight percent of students were classified as economically disadvantaged. Assignment of schools to one of three conditions (5 to the RA condition, 5 to the RR condition, and 5 to a control condition) was conducted prior to baseline assessment using a multi-attribute randomization protocol, accounting for school size, racial/ethnic composition (percent of African-American and Hispanic students), and geographic location.[18]Assuming 15% of controls would initiate any type of sex by 9 th grade, 25% attrition, intraschool correlations=0.005, and α=0.05 (two-tailed), an initial sample size of 1,500 7 th grade students was estimated to provide 80% power to detect 10% pairwise differences in sexual Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript initiation between intervention and co...

IntroductionThe objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes.MethodsWe forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs.ResultsThe incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters.ConclusionThe CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.

Examination of social capital and its relationship to disaster preparedness has grown in prominence partially due to world-wide need to effectively respond to terrorist attacks, viral epidemics, or natural disasters. Recent studies suggested that social capital may be related to a community’s ability to plan for and respond to such disasters. Few studies, however, have examined social capital constructs among low income populations living in disaster prone areas and accounted for the influence of social capital at the individual and community level. We examined social capital as measured by perceived fairness, perceived civic trust, perceived reciprocity and group membership. We undertook a multistage random cluster survey in three coastal counties in Texas (U.S.) noted for their high levels of poverty. Individuals from 3088 households provided data on social capital, socioeconomic and demographic characteristics, and self-reported level of preparedness for a hurricane. We used multivariable logistic regression to test potential associations between social capital measures and disaster preparedness. After adjusting for age, gender, marital status, ethnicity, education, employment, household income, acculturation, self-reported health, special needs persons in household, household size, and distance to the shore we found a higher prevalence of preparedness among individuals who reported the highest perception of fairness [AOR=3.12, 95% CI: (1.86, 5.21)] compared to those individuals who reported lowest perceptions of fairness. We also found a higher prevalence of preparedness [AOR= 2.06; 95% CI: (1.17, 3.62)] among individuals who reported highest perceptions of trust compared to individuals who reported lowest perceptions of trust. Perceived reciprocity and group membership were not associated with preparedness. These results extend previous findings on social capital and disaster preparedness and further characterize social capital’s presence among a low income population living in a hurricane prone area.

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